Umbilical Cord Hypercoiling with Stricture and Intrauterine Fetal Death: Association with Maternal Factors and Implications for Pathogenesis

Introduction: Hypercoiling of umbilical cord with stricture (HCS) is one of the most common etiologies of intrauterine fetal death (IUFD). Whether Wharton's Jelly close to fetal abdomen plays roles in pathogenesis is controversial. Methods: Fetal autopsies were reviewed between 2015 and 2022 and HCS with maternal and fetal factors were examined to determine if these factors were relevant to HCS and IUFD. Results: Totally 389 fetal autopsies were reviewed and 75 cases of HCS were identified. HCS was found more frequently in older (maternal age ≥35) multiparous women with longer cords and increased umbilical coiling index (UCI) (both p < 0.01). There was no significant difference in maternal race/ethnicity, BMI, fetal sex, genetics, seasonality, multiple pregnancies or anomalies in HCS. Conclusions: HCS appeared related to maternal characteristics and it occurred more frequently in older multiparous women associated with longer cords. Lack or poorly developed Wharton's jelly close to fetal abdomen plays important role in IUFD.